Family Planning Summit: dilemmas of UK exceptionalism, private v public and population control

Are we now in a period of global British exceptionalism in aid and development, and if so, what are the implications for the work of British-based NGOs and their allies? That question has been niggling away at me during the run-up to the big UK government + Gates Foundation ‘Family Planning Summit’ tomorrow.

Why exceptionalism? Because the UK is pretty much alone among traditional donors in sticking to its promises to increase aid despite deep public spending cuts, and is simultaneously pushing ahead in the multilateral arena, with a Hunger Summit scheduled during the Olympics, tomorrow’s Family Planning Summit and David Cameron as one of the three co-chairs (with the leaders of Indonesia and Liberia) of the UN panel to look at what comes after the MDGs.

That leadership places organizations like Oxfam in an extreme ‘cup half full/empty’ quandary. There are strong arguments in both directions: should we join in as a cheerleader, building UK public support for the government’s brave (and among some of the right wing press, deeply unpopular) stance, bigging up its leadership to try and shame other governments into following suit? To do that means biting our tongue on some unpalatable aspects of the government’s policies we just don’t think will be effective (see below).

Or should we opt for the role of critic, stressing our areas of disagreement, or what still needs to be done. That may be truer to our convictions and analysis, but it risks undermining public support for aid, losing the chance to influence other countries, and, let’s be honest, landing ourselves in a big row with the government. The standard NGO default of chucking in a congratulatory first paragraph, and then starting the second para with ‘But…..’ doesn’t fool anyone because, as a civil servant once informed me, everyone knows that ‘everything above the ‘but’ is bollxxks’.

So back to the summit. First the stats, which you will see endlessly rehearsed if the organizers get their media work right. 215 million women and girls in developing countries who want to delay, space or avoid becoming pregnant are not using effective methods of contraception, resulting in over 75 million unintended pregnancies every year. This puts women and girls at serious risk of death or disability during pregnancy and childbirth, including from unsafe abortions, particularly where quality of care is inadequate.

If those 215 million women and girls used modern methods of family planning, unintended pregnancies would fall by more than 70 percent, and each year there would be nearly 100,000 fewer maternal deaths and nearly 600,000 fewer newborn deaths.

In response, the Summit is launching an effort to ‘make available affordable, lifesaving contraceptive information, services, and supplies to an additional 120 million women and girls in the world’s poorest countries by 2020.’ i.e. halve the number of women excluded from family planning systems. That’s amazing, especially in times like these. Hats off. Get out there and support this.

So (and carefully avoiding use of the word ‘but’) why the lingering discomfort? Let’s pick three issues: supply v demand; private v public and population. Of these, I think the first is debateable, the second substantive, and the third is a framing issue that I hope we can sort out quickly.

Supply v demand: there’s no point in providing condoms or pills if women are prevented from using them, if there’s no information available, or health systems are unable to look after those women who chose to have children. This is obvious and accepted by everyone, but it’s an

It's about systems, not just contraceptives

important question of balance. Solving the shortfall in sexual and reproductive health services (this is about much more than contraceptives) is as much about systems as stuff. I’m not completely clear from the documents I’ve read, but the concern is clearly that the summit is skewed towards stuff, although Andrew Mitchell, the UK Development Minister, clearly backs demand-side rights when he says the summit is about “poor women who want contraception but can’t get it. We’re trying to ensure that women have the opportunity to decide for themselves.”

Private v public: on health issues, this is probably the most genuinely divisive topic. To what extent are health services like family planning best delivered free at the point of use via a public health system, or should the preference be to involve private sector delivery mechanisms. Oxfam’s reading of the research suggests the benefits of the latter approach are unproven, but the organizers clearly want to involve the private sector to a significant extent – is the underlying driver ideology or evidence?

Population: The Summit is being held on World Population Day. Depending on your viewpoint, that is a brave attempt to take on the ‘too many Africans’ school of population controllers, and reassert what really matters in this debate – women’s ability to exercise control over their fertility (and to be fair, the population lobby have moved a long way towards women’s rights in recent years). Or it’s a dangerous conflation of two issues that are related, but not nearly as closely as some controllers make out. My colleague Ricardo Fuentes has been crunching the numbers on one aspect: how important is population growth in poor countries to climate change (see previous post on this)? The answer is not very much. In the 25 years to 2005, Sub-Saharan Africa accounted for almost a fifth of the growth in the world’s population but only 2.4 per cent of the increase in CO2 emissions. By contrast, North America was responsible for 4 per cent of population growth but 13.9 per cent of the rise in emissions (i.e. nearly 6 times as much as Africa). Attacking climate change through population control would mean reducing the number of Americans, not Africans (not a policy I would espouse by the way – some of my best friends etc).

So there’s my ‘cup half full/empty’ summary. It’s fine for the blog, but too complicated for soundbites. That’s where the trouble starts.

What else to read? Here’s the increasingly impressive Melinda Gates making the case in the Guardian and voicing over (voiceovering?) a youtube animation setting out the economic rationale

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Good summing up of the dilemmas. The public/private family planning debate is a bit more nuanced than you suggest. It goes back to the late 1960s when condom distribution through commercial channels began to be promoted by non-profit agencies and – in the case of India’s “Nirodh” condom – by the state. At that time FP services in many developing countries were provided by NGOs – typically the Family Planning Associations – many of which were in fact funded by aid donors including the UK Government. At that time the campaigning agenda was focused on legalization and getting UN agencies to promote reproductive health rights (leading to the setting up of the UNFPA. Today the focus has to be on so-called “cultural” barriers, usually with a strong gender bias, from religious and other reactionary quarters.

In this and your last blog, you appear to give support to the suggestion that climate change is the most significant problem that we face and not just a symptom of a much wider problem. You suggest, reasonably, that an increasing sub Saharan population does not add to carbon emissions in the way that demand growth does within the most affluent countries.

You seem, though, to underestimate the other symptoms of resource depletion and species loss. Surely, increasing populations anywhere will require more arable land and at least one depleting resource, clean water.

The Earth is finite and increasing the number of human beings has put ever greater pressure on the evolved ecosystems on which all life depends. I often wonder why the idea of a finite planet is so hard to comprehend.

Excellent post as always Duncan but (and the words before but are genuine not bollxxks!) on public v private, ideology isn’t a dirty word. Public services are what we want no just because the evidence shows it is better (as Oxfam have shown it does) but because we have a different value set that sees health and education as public goods leading to more equitable outcomes, whose curriculum is determined by (in theory) accountable politicians democratically elected by us.

Great post. Many of the issues you raise are being researched by the Pop-Pov Research Network, funded by the William and Flora Hewlett Foundation, the UK’s Economic and Social Research Council and others. For more details about funded projects and access to working papers and published research papers see: http://www.poppovresearchnetwork.org/

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This is a conversational blog written and maintained by Duncan Green, strategic adviser for Oxfam GB and author of ‘From Poverty to Power’.
This personal reflection is not intended as a comprehensive statement of Oxfam's agreed policies.